Heart of a Lion, Hands of a Woman: What Women Neurosurgeons Do
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Friday, December 31, 2010

Is it a surprise?

Our population is getting older and increasingly, medical decisions are being made in a relative vacuum...what real experience is there for treating 85-90 year olds with breast cancer? how do we manage the couple each over 95 and generally healthy but now with one needing surgery?do we remove brain bleeds in patients over 90? over 95? over 100? How do we guide our decisions? And are the 85+ of today like those few who may have been studies a decade ago? and perhaps more importantly are today's 85+ the same as those that will reach that milestone in the next 1-2 decades the same?
There is so little that is known about this entire issue.  I have been proposing for years that a fortune could be made by the right enterprising person in establishing specialized medical facilities for our "geriatric" population.  I know we now have geriatricians but that doesn't mean we have figured out how to best administer care to this population or how to best manage their multifaceted issues.  Most people I know (personally or professionally) who are over 65 are seeing a minimum of 3 physicians and many are regularly seeing 5 or more (PMD, cardiologist, gynecologist, gastroenterologist, urologist, orthopedic...).  I see a high incidence of depression and as a specialist unrelated to most of the "common" disorders, I sense a complete lack of understanding of (on the patient's part) of the purpose of their medications and (on the doctor's side) or their potential for interaction.
So I was not the slightest bit surprised to see a recent article in the NEJM that demonstrated that coordinated care for medical and psychological issues leads to better outcomes.  The only surprise was that such a study need be done to prove such an obvious concept.  Our health care system is truly challenged and will only become more so with the advancing age of our population-we need to find a new paradigm for treating this group of patients and to better understand the effectiveness (and thus the need) for our interventions.  This must be a rallying cause for 2011!
The best over 90 woman I have ever known-my Grandmother Frieda

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